The first thing to do is to set a date for when the pathways will begin to be used. Usually, from this date forward, new admissions are put on pathways. Then, another date is set for when to transition current patients onto pathways at the time of their recertification (usually 2 to 4 weeks following the first date). Only current patients that will be on service for more than two weeks are transitioned into pathways. It may not be feasible or applicable to place existing patients on pathways if the discharge date is soon. This procedure for initiating the pathways allows the clinicians to transition into the use of the pathways over a period of time, rather than starting all patients on pathways at once. 

Some agencies choose to limit the pathways the clinicians may use in the beginning of implementation. They feel that this strategy would be less overwhelming for the clinician. For example, they may begin with the top five or ten high frequency conditions. However, when agencies do this, they have a much longer transition time and a much longer time with two documentation systems going at one time. This can be very cumbersome for the clinician. Also, sometimes agencies that limit pathways to a select few, the agency doesn’t get the usually number of referrals for those conditions. This slows the transition process down as well. Lastly, in some agencies, the clinicians that are limited to certain pathways tend to ask for all the other pathways once they start using the pathways. They find the pathways user friendly and find it hard not to use them for all of their patients. 

On the other hand, some agencies do not limit the pathways to be used during the beginning of implementation of the pathways. At the time of the implementation date, all new admissions are placed on pathways. From the time of the second date, all current patients are transitioned onto pathways. Agencies who have implemented the pathways in this manner seem to have a smooth transition into the pathways. The transition period from the old documentation/care planning system to the new pathway system is usually achieved within 60 days.